When Patients Ask About Barefoot Running And Minimalist Shoes
Have you seen an increase in injuries with barefoot/minimalist running? If so, do these injuries differ from other running injuries you have treated in the past?
The majority of the panelists have seen an increase in metatarsal stress fractures and Achilles tendon injuries. Dr. Sanders says these runners typically present with an insidious onset (usually three to four weeks) of osseous injury. In Dr. Sanders’ experience, the most common fractures involve the metatarsal bases. She notes these fractures are more severe than typical overuse stress fractures as these injuries almost always require non-weightbearing immobilization with crutches to heal. In 50 percent of these injuries, radiographic findings are unremarkable and MRI is required for definitive diagnosis, according to Dr. Sanders.
“The problem with these injuries is they start out as an annoyance and slowly build from discomfort to pain without a specific inciting event, causing the runners to continue training in spite of injury,” points out Dr. Sanders.
In his experience, Dr. Johncock has found that the majority of the metatarsal and Achilles injuries occur in patients who are older (over the age of 30), those who changed their shoe style too quickly in his opinion or a combination of both.
“The key to reinforce to your patients who wish to try this is it must be a very gradual transition and the older you are and the longer you have run with traditional shoes, the longer this transition will be. Think months/years, not weeks,” says Dr. Johncock.
Form and function will change, emphasizes Dr. Romansky. When people run barefoot or with minimalist shoes, he says they will be using muscles and joints more or less than with previous shoes. Dr. Romansky maintains that a change of shoe changes how you run and subsequently new horizons of function create new injury patterns.
“Changes in the form and function of a shoe ultimately dictate injury pattern,” emphasizes Dr. Romansky.
In addition to the aforementioned metatarsal fractures and Achilles tendon injuries, Dr. Romansky has seen a lot of soft tissue injuries, proximal “up the line” injuries including a high hamstring at the origin of the buttocks, distal hamstring issues at the insertion of the posterior knee, injury to the medial head of the gastrocnemius recession and injury to the sacroiliac joint. Dr. Kirby has also seen gastrocnemius/soleus muscle injuries as well as metatarsophalangeal joint capsulitis/plantar plate injuries in addition to the aforementioned metatarsal stress fractures and Achilles tendon injuries. He says these specific injuries result from barefoot runners landing more on their forefoot than their rearfoot.
“Since the only three scientific studies that have been done on this subject have shown that 75 to 89 percent of runners are rearfoot strikers, I tell runners it is a mistake for them to try to run in a totally different manner than what is natural for them,” explains Dr. Kirby.4-6 “In other words, runners shouldn’t go from rearfoot striking to forefoot striking just because some ‘expert’ on the Internet said that rearfoot striking and thicker-soled shoes are harmful.”
While Dr. Blake says he has no basis with which to judge if there has been an increase of injuries with the recent barefoot running/minimalist shoe movement, the injuries he has seen have been a combination of minimalist shoes not providing good support or protection, and the athletes being careless about their training regimen with these shoes. For example, Dr. Blake cites an elite runner who switched to minimalist shoes and broke her heel bone, but notes that she also did not change her technique. He says another runner in Vibram Five Fingers stepped up onto a curb and developed severe turf toe in the second toe. “(This) would not have happened in normal shoes,” notes Dr. Blake.